| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,452 |
15,410 |
$659K |
| D0120 |
Periodic oral evaluation - established patient |
10,500 |
10,467 |
$646K |
| D1310 |
|
6,673 |
6,649 |
$283K |
| D1206 |
Topical application of fluoride varnish |
15,389 |
15,347 |
$272K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,836 |
2,826 |
$190K |
| D1351 |
Sealant - per tooth |
4,999 |
1,378 |
$158K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,138 |
2,134 |
$140K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,422 |
11,146 |
$117K |
| D9993 |
|
1,955 |
1,955 |
$89K |
| D0272 |
Bitewings - two radiographic images |
7,407 |
7,385 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,263 |
882 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,661 |
1,541 |
$66K |
| D0603 |
|
4,130 |
4,116 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,070 |
2,064 |
$41K |
| D9430 |
|
1,204 |
1,172 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,058 |
2,034 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
272 |
175 |
$18K |
| D0602 |
|
1,209 |
1,205 |
$17K |
| D0601 |
|
1,043 |
1,034 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
113 |
88 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
78 |
$9K |
| D0330 |
Panoramic radiographic image |
312 |
309 |
$9K |
| D1354 |
|
119 |
38 |
$980.00 |
| D1999 |
|
44 |
42 |
$0.00 |